Indian Journal of Pathology: Research and Practice

Areas of hypoxia in squamous cell carcinomas of the oral cavity lead to various adaptive mechanisms like anaerobic glycolysis, altered gene expression and deviations in the cellular proteome. These mechanisms not only thwart cellular death but enable rapid progression of growth, culminating in poor prognosis. Amongst a wide number of biomarkers stimulated by hypoxic conditions in oral squamous cell carcinoma (OSCC), the most notable ones are hypoxia-inducible factors (HIF), vascular endothelial growth factors (VEGF) and aquaporins (AQP). In several cancers, including OSCC it has been observed that HIF plays the role of a crucial transcriptional activator. This leads to the downstream expression of several genes that control the process of tumour angiogenesis. The most significant of these genes is VEGF, which has a dominant role as a regulatory gene controlling angiogenesis. VEGFs are a diverse family consisting of which primarily VEGF-A has an essential role in regulating angiogenesis in specific vascular endothelial cells. This is critical for the cellular functions of cancerous tissues to adapt to hypoxic conditions. In addition, VEGF has an immune-regulatory property, thereby modulating immune cell antitumour activity. Another potential biomarker is AQP, a family of transmembrane water channel proteins, that plays a role in transcellular and transepithelial water transport. Unlike AQP1, AQP2, AQP4, AQP5, and AQP8, which exclusively transport water, AQP3, AQP7, AQP9, and AQP10 transport glycerol and other small solutes, and so are termed as “aqua-glyceroporins”. Studies have implicated AQP in the molecular mechanism of oncogenesis across many cancers, where they help in the proliferation of cells, cellular migration, invasiveness and angiogenesis.

Pathology is the discipline of diagnosing a disease mostly through analysis of tissues cell and body fluid samples. Over the past few years, deep learning has created quite a hype about artificial intelligence in healthcare. The practice of diagnostic pathology has gone through a transformation wherein new tools such as digital imaging, advanced artificial intelligence algorithms and computer aided diagnostic techniques are being used for assisting, augmenting and empowering the computational histopathology and AI enabled diagnostics. This is paving the way for advancement in precision medicine in cancer. In this article, the milestones and landmark trials in computational pathology are discussed along with emphasis on future directions.

Background: Basal cell carcinomais a slow growing malignant cutaneous non melanocytic tumor that is locally aggressive but it rarely metastasizes. Case of 61 year male presented to the outpatient department with a round, nonhealing ulcer with hyperpigmentation, measuring 2.5x2.1x0.8cm over the right side of face, 1.8 cm below the right eye region for the last 1.5 years. Patient had history of swelling at same site 1.5 year back, as small nodular lesion which was excised. The general physical and systemic examinations were normal. The lesion was surgically excised with wide margins. The specimen on gross measured 2.3x2.1x0.6cm, firm, grey brown to black colored hyperpigmented with rolled out margins and central ulceration measuring 1.6x1.4x0.6cm. Cut section was grey white, nodular with blackish pigmentations. On microscopic examination showed a circumscribed nodular lesion composed of neoplastic cells arranged in large basaloid lobules with peripheral nuclear palisadations. The neoplastic basaloid cells with scant cytoplasm and hyperchromatic nuclei were seen. The stroma was fibromyxoid with focal inflammation. The surface ulceration was noted. The nodules are variable size of more than 0.3cm diameter. Tumor showed epidermal attachment. In areas the reticulate, pseudoglandular pattern of basaloid neoplastic cells were noted with a mucinous stroma. Focal areas of colonization of tumor's complexes with melanocytes and stromal melanophages pigmentation was noted. The tumor showed 0.5cm depth of invasion. The mitotic activity was low, minimal atypia and apoptosis were noted. The lymphovascular, perineural invasion was absent. All peripheral and deep surgical margins were free from tumor. On histopthological findings reported as Basal cell carcinoma-nodular, adenoid cystic and pigmented: mixed histological subtype over face. The patient was kept on regular follow up. There was no evidence of recurrence or any metastasis. Conclusion: We present this rare case of Basal cell carcinoma-nodular, adenoid cystic and pigmented: mixed histological subtype for its clinical and morphological findings. The pathological diagnosis and classification of BCC are essential for the evaluation of the tumour type, its biological behaviour, risk assessment of the recurrence and treatment.

Background: Hydatid disease is a widespread parasitic infection, particularly endemic among communities engaged in sheep rearing activities. Although it commonly affects the liver and lungs, rare cases of cysts found in the breast have been reported. It is a challenge to distinguish these lesions from other breast tumours. Case report: A 37-year-old female presented with a painless lump in the right breast since three years. On ultrasound of the breast, multiloculated thick-walled cystic lesion was seen in the lower part of the right breast, raising suspicion of hydatid cyst. The patient underwent an excision biopsy. On gross examination, a cystic structure was seen, with multiple pearly white cysts on opening.Histopathological features of hydatid cyst scolex were identified, with adjacent breast parenchyma showing foreign body giant cell reaction. Discussion: Typically, patients with breast hydatid cysts present with a painless lump in the breast, which gradually increases in size without involvement of regional lymph nodes. The presentation may mimic other breast conditions such as fibroadenoma, phyllodes tumors, chronic abscesses, or even carcinoma. Therefore, breast hydatid cyst should be considered in the differential diagnosis of breast lumps, particularly in endemic areas. Conclusion: Although rare, the presence of multiloculated cysts in the breast tissue should raise the suspicion of hydatid disease in differential diagnosis of breast lumps for patients living in endemic areas.

Chorangiomas are benign neoplastic lesions of the placenta and usually are a common incidental finding, but giant chorangiomas that measure more than 5cm in diameter are rare. Small chorangiomas typically do not cause detrimental consequences. But giant chorangiomas may lead to both fetal and maternal complications such as fetal congestive cardiac failure, fetal hydrops, polyhydramnios, preterm labor, and even intrauterine fetal demise. Here, we report a case of a primigravida at 22 weeks and three days of gestation presented with a giant placental chorangioma leading an adeversefetal outcome.